Basic Information
| Provider Information | |||||||||
| NPI: | 1942266374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTKER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3409 WORTH ST | ||||||||
| Address2: | 710 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148232533 | ||||||||
| FaxNumber: | 2148248679 | ||||||||
| Practice Location | |||||||||
| Address1: | 3409 WORTH ST | ||||||||
| Address2: | 710 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148232533 | ||||||||
| FaxNumber: | 2148248679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 08/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | E5261 | TX | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 440000050 | 01 | TX | RAIL ROAD MEDICARE | OTHER | MDE5261 | 01 | TX | WORKERS COMP | OTHER | 4046840 | 01 | TX | AETNA | OTHER | 83M391 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | E5261 | 01 | TX | STATE LICENSE | OTHER | 124502902 | 05 | TX | MEDICAID | 2226817 | 01 | TX | BLUE LINK | OTHER |